Booster dose

In medicine, a booster dose is an extra administration of a vaccine after an earlier (prime) dose. After initial immunization, a booster injection or booster dose is a re-exposure to the immunizing antigen cell. It is intended to increase immunity against that antigen back to protective levels after it has been shown to have decreased after a specified period. For example, tetanus shot boosters are often recommended every 10 years.[1] The need for a booster dose is evaluated in several ways, including the immune response after a booster dose is administered, active B and T cell activity after a certain amount of time that the primary vaccine was given, and prevalence of the disease in vaccinated populations.[2] Anamnestic response, the rapid production of antibodies after a stimulus of an antigen, is a typical way to measure the need for a booster dose of a certain vaccine. If anamneestic response is high after receiving a primary vaccine many years ago, there is most likely little to no need for a booster dose.[3]

If a patient receives a booster dose but already has a high level of antibody, then a reaction called an Arthus reaction could develop, a localized form of Type III hypersensitivity induced by high levels of IgG antibodies causing inflammation.[4] The inflammation is often self-resolved over the course of of a few days, but could be avoided altogether by increasing the length of time between the primary vaccine and the booster dose.[5]

It is not yet fully clear why some vaccines such as Hepatitis A and B are effective for life, and some such as tetanus need boosters. In most cases, the booster serves as a 'reminder' to the immune system. [6] This is especially pertinent if the immune system responds to a primary vaccine rapidly, so that the body does not have time to sufficiently develop immunological memory against the disease.

Polio Booster Doses

In the case of the Polio vaccine, the oral polio vaccine (OPV) decreases in strength after only six months of consumption. Booster doses of the OPV were found ineffective, as they, too, resulted in decreased immune response six months after consumption. However, when the inactive polio vaccine (IPV) was used as a booster dose, it was found to increase the test subjects' antibody count by 39%-75%. This is in contrast to when IPV is used as the primary immunity, during which the immune response is low, allowing the virus to incubate in the gut and potentially attenuate to its fully reproductive form.[7] In this instance, neither OPV nor IPV was effective enough to not require a booster dose, but instead OPV is administrated as a primary vaccine and IPV as a booster vaccine.

In the United States, only the IPV is used. In rare cases (about 1 in 2.7 million), the OPV has reverted back to a strengthened form of the illness, and caused paralysis in the recipients of the vaccine. For this reason, the US only administers IPV, which is given in four increments (3 within their first year and a half after birth, then one booster dose between the ages 4-6).[8]

Hepatitis B Booster Doses

The need for a booster dose for Hepatitis B has long been debated. Studies in the early 2000s showed that fully vaccinated adults (those that received all three primary vaccines at the correct time sequence when they were young) do not require a booster dose--the CDC and Canadian National Advisory Committee supported these recommendations by publicly advising against booster doses for Hepatitis B. [9] Studies reached this conclusion by measuring immune response against the Hepatitis B antigen, and observing a significantly high memory response of the immune system in adults. [9] Immuno-repressed individuals were advised to seek further screening to evaluate their immune response to Hepatitis B, and potentially receive a booster dose if their antibodies against Hepatitis B decrease below a certain level.

Tetanus Booster Dose

The tetanus disease requires a booster dose every 10 years, or in some circumstances immediately following infection of tetanus. Td is the booster for adults, and differs to other forms of the vaccine as it does not include immunization against pertussis. [10] While the US recommends a booster every 10 years, other countries, such as the UK, suggest just two booster shots within the first 20 years, but not extending into a third decade.[11] Neonatal tetanus is a recently surfaced concern, and mothers are recommended a booster against tetanus during their pregnancy in order to protect their child against the disease.[12]

See also

References

  1. ↑ Tetanus: Prevention, Mayo Clinic, 2006-09-21, retrieved 2008-07-17
  2. ↑ Leuridan, Elke; Damme, Pierre Van (2011-07-01). "Hepatitis B and the Need for a Booster Dose". Clinical Infectious Diseases 53 (1): 68–75. doi:10.1093/cid/cir270. ISSN 1058-4838. PMID 21653306.
  3. ↑ Van Damme, Pierre; Van Herck, Koen (2007-03-01). "A review of the long-term protection after hepatitis A and B vaccination". Travel Medicine and Infectious Disease. 1st International Conference of Travel Medicine and Infectious Disease1st International Conference of Travel Medicine and Infectious Disease 5 (2): 79–84. doi:10.1016/j.tmaid.2006.04.004.
  4. ↑ Committee, Institute of Medicine (US) Vaccine Safety; Stratton, Kathleen R.; Howe, Cynthia J.; Richard B. Johnston, Jr (1994-01-01). "Immunologic Reactions".
  5. ↑ University of the Sciences in Philadelphia, David B. Troy, Joseph Price Remington, Paul Beringer (2005). Remington: the science and practice of pharmacy. Lippincott Williams & Wilkins. ISBN 0-7817-4673-6.
  6. ↑ "Top 20 Questions about Vaccination — History of Vaccines". www.historyofvaccines.org. Retrieved 2016-01-30.
  7. ↑ Jafari, Hamid; Deshpande, Jagadish M.; Sutter, Roland W.; Bahl, Sunil; Verma, Harish; Ahmad, Mohammad; Kunwar, Abhishek; Vishwakarma, Rakesh; Agarwal, Ashutosh (2014-08-22). "Efficacy of inactivated poliovirus vaccine in India". Science 345 (6199): 922–925. doi:10.1126/science.1255006. ISSN 0036-8075. PMID 25146288.
  8. ↑ "Vaccines: VPD-VAC/Polio/main page". www.cdc.gov. Retrieved 2016-02-09.
  9. 1 2 Leuridan, Elke; Damme, Pierre Van (2011-07-01). "Hepatitis B and the Need for a Booster Dose". Clinical Infectious Diseases 53 (1): 68–75. doi:10.1093/cid/cir270. ISSN 1058-4838. PMID 21653306.
  10. ↑ "Vaccines: VPD-VAC/Tetanus/main page". www.cdc.gov. Retrieved 2016-02-09.
  11. ↑ Cook, T. M.; Protheroe, R. T.; Handel, J. M. (2001-09-01). "Tetanus: a review of the literature". British Journal of Anaesthesia 87 (3): 477–487. doi:10.1093/bja/87.3.477. ISSN 0007-0912. PMID 11517134.
  12. ↑ Rodrigo, Chaturaka; Fernando, Deepika; Rajapakse, Senaka (2014-01-01). "Pharmacological management of tetanus: an evidence-based review". Critical Care 18 (2): 217. doi:10.1186/cc13797. ISSN 1364-8535. PMC 4057067. PMID 25029486.


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